Acid reflux

Dr. Nadheer K M (AIIMS)MBBS

November 17, 2020

November 17, 2020

Acid reflux
Acid reflux

Acid reflux is also known as heartburn, as it is usually felt as a burning sensation in the lower chest. People with this condition may experience chest pain (in the middle of the chest), a sour or bad taste in the mouth, bad breath and hoarse voice. Sometimes an itchy throat can be a sign of "silent" acid reflux, meaning that the patient doesn't show any other signs of heartburn.

Despite being called heartburn colloquially, acid reflux has nothing to do with the heart. As the name suggests, acid reflux occurs when some of the hydrochloric acid from the stomach comes up into the food pipe.

Most of us have experienced the unpleasantness of acid reflux at least once in our lives (read more: Acid reflux in babies). But if you routinely get acid reflux while sleeping or if you have acid reflux along with symptoms like sore throat and persistent dry cough, you should see a doctor for it.

Sometimes a small amount of acid can irritate the throat—this may occur even if the diagnostic tests come back negative for acidity problems like gastroesophageal reflux disease or GERD.

Some factors that increase the risk of acid reflux include lifestyle factors like obesity and smoking and life stages like pregnancy. (Read more: Acidity during pregnancy)

Diagnosis is usually done based on the symptoms and tests like pH monitoring. Treatment can vary from taking an over-the-counter antacid to longer-term treatment.

Read on to know more about the symptoms, causes, diagnosis, treatment and lifestyle changes for acid reflux.

Causes of acid reflux

Our stomach produces a strong acid—hydrochloric acid—to help the body break down food and digest it, as well as to protect us against any pathogens that we might ingest.

During digestion, the gastroesophageal sphincter—the ring muscle that acts as a valve between the stomach and the food pipe—lets food into the stomach but not back up the oesophagus (food pipe) again.

Acid reflux happens when this valve malfunctions. There could be several reasons for gastroesophageal sphincter malfunction:

  • GERD is characterised by acidity issues
  • Hiatal hernia, a condition in which a part of the stomach pushes through into the chest, can cause acid reflux
  • When you eat spicy or oily food or drink too much coffee or tea, that too relaxes this valve and can result in acidity
  • Certain medications like anxiety medications, antibiotics, antidepressants, high blood pressure medications, nitroglycerin (used to ease angina and treat coronary artery disease), osteoporosis medications and pain relief medication like ibuprofen may also cause acid reflux (do not discontinue any medicines without talking to your doctor)
  • Acid reflux is both a risk factor and a symptom of Barrett's oesophagus and oesophagal cancer
  • Stomach cancer can also cause acid reflux
  • Stress increases the perception of stomach acids in the oesophagus

Symptoms of acid reflux

The common symptoms of acid reflux include:

  • Regurgitation of sour liquid or food in the mouth 
  • Feeling bloated
  • A burning sensation in the chest after consuming food 
  • Chest pain 
  • Sore throat 
  • Burping a lot
  • Difficulty swallowing could be a sign of laryngopharyngeal reflux caused by small amounts of stomach acid coming into the throat. Left untreated, it can cause laryngitis which may be seen as hoarse voice and eventually loss of voice

Risk factors for acid reflux

There are certain things that make it more likely for a person to experience acid reflux. Unlike most conditions, age is not a risk factor for acid reflux. However, some life stages and lifestyle problems can increase your chances of experiencing it. These include:

  • Being overweight or obese
  • Pregnancy: Pregnant women get acid reflux, especially in the third trimester when the growing uterus and baby push the mom-to-be’s organs to up and aside. During pregnancy, the hormones also cause the lower oesophagal sphincter (the valve between the stomach and food pipe) to relax and result in acidity
  • Smoking: Be it active smoking or passive smoking, both are triggers for acid reflux
  • Lying down right after a meal 
  • Eating heavy meals and then bending forward 
  • Snacking late at night/ before bedtime
  • Consuming carbonated beverages or alcohol
  • Sleep disturbances (sleep deprivation)
  • Consuming foods such as garlic, onion, tomatoes, citrus (example, lemon) and chocolate
  • Apart from these environmental factors, genes also play a role in determining the risk for acid reflux, GERD, Barrett's oesophagus and oesophagal cancer.

Complications of acid reflux

Acid reflux can damage the lining of the food pipe and the valve that protects the food pipe from the contents of the stomach. Some complications that can arise because of acid reflux are:

  • Gastroesophageal reflux disease or GERD: If the person starts experiencing acid reflux as frequently as twice or more than that a week, they should see a doctor soon to rule out GERD.
  • Barrette’s oesophagus: In this condition, an abnormal change in the mucosal cells lining the lower portion of the oesophagus is detected—basically repeated exposure to stomach acids changes the lining of the food pipe, making it more like the lining of the intestines. This is a precancerous condition and a risk factor for oesophageal cancer.
  • Laryngitis: Inflammation of the larynx and vocal cords can occur when stomach acids irritate the throat.

Treatment of acid reflux and lifestyle changes for acid reflux

If GERD or medications like hypertension medicine is giving you acid reflux, then it's important to talk to your doctor for the proper medication.

If you are pregnant and having acid reflux, talk to your gynaecologist about safe ways to reduce your discomfort. Certain home remedies for acid reflux may help—talk to your gynaecologist before taking them though.

Having said that, some lifestyle changes and medicines can help you irrespective of the cause of your acid reflux:

  • Medication: Antacids may be taken to neutralize the acid in the stomach. Proton pump inhibitors such as rabeprazole, dexlansoprazole and esomeprazole, etc., are also effective. (Some of these medicines are available without a prescription, but if you have a previous health condition or if you are already taking medicines for another health condition, then talk to your doctor before taking these.)
  • Quit smoking: There are many benefits to quitting smoking. If you have the habit of chewing tobacco or smoking, chances are this is triggering your acid reflux. The nicotine content in tobacco relaxes the lower oesophagal sphincter, allowing the stomach acid/juices back into the food pipe.
  • Lose weight: Being overweight may increase the pressure on your abdomen, making the backflow of acid more likely.
  • Eat smaller portions: Bigger meals can make you feel over-full and trigger indigestion. Eating smaller portions can also help pregnant women and people living with GERD.
  • Avoid certain foods: If certain foods like tomatoes, coffee, chocolate can trigger your acid reflux, avoid them. Too much of spicy and fatty foods trigger acid reflux in most people. Eat a balanced diet, to avoid acid reflux and maintain a healthy weight.
  • Avoid late-night snacks: GERD and acid reflux can disrupt sleep and sleep deprivation can worsen GERD. Eat two to three hours before going to bed and try sleeping positions like lying on your left side rather than on your back. 
  • Dress comfortably: Wear loose-fitting clothes to avoid pressure on the abdomen.
  • Exercise: Overall good health and healthy weight help to minimise problems with the gastroesophageal sphincter.

Takeaways for Acid Reflux

Most people experience acid reflux. Even though it can result in discomfort, it is usually not a critical problem and can be taken care of by making small but effective lifestyle changes.



References

  1. NA Tobey JL Carson RA Alkiek RC Orlando Dilated intercellular spaces: A morphological feature of acid reflux- damaged human esophageal epithelium |American Gastroenterological VOLUME 111, ISSUE 5, P1200-1205, NOVEMBER 01, 1996
  2. SMOUT, A.J.P.M. (1997), Endoscopy‐negative acid reflux disease Alimentary Pharmacology & Therapeutics, 11: 81-85.
  3. Tack, J., M.D., Ph.D.; Koek, G., M.D., Ph.D.; Demedts, I., M.D., Ph.D.; Sifrim, D., M.D., Ph.D.; Janssens, J., M.D., Gastroesophageal Reflux Disease Poorly Responsive to Single-Dose Proton Pump Inhibitors in Patients without Barrett's Esophagus Acid Reflux, Bile Reflux, or Both? American Journal of Gastroenterology: June 2004 - Volume 99 - Issue 6 - p 981-988
  4. Whiteman DC, Sadeghi S, Pandeya N, et al Combined effects of obesity, acid reflux and smoking on the risk of adenocarcinomas of the oesophagusGut 2008;57:173-180.

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